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A Cooperation Crisis: Should Young Doctors Be Forced to Serve in Rural Areas?

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An estimated ten to fifteen thousand medical and paramedical students protested yesterday against the Ministry of Health proposal to introduce a compulsory medical service. (Photo: Conseils Des Étudiants en Médecine au Maroc)

 

Floating through the ACCESS Health Rabat office windows comes the rhythmic sound of thousands of feet hitting the pavement, of chanting, of police whistles. Rows and rows of white clad protesters file past with banners held high and voices raised in anger. Our offices are very close to the Parliament of the Kingdom of Morocco, and it is there that the protesters want their voices heard.

An estimated ten to fifteen thousand medical and paramedical students marched in protest yesterday against the Ministry of Health proposal to introduce a compulsory medical service. The proposal aims to overcome the lack of doctors in the poor and rural areas by obliging medical students to work there for two years. Doctors will not receive their diplomas until they have completed their medical service.

The Ministry of Health has long been trying to tackle the imbalance in the geographical distribution of doctors and paramedics. Forty five percent of doctors are installed in just two regions in Morocco, where the cities of Casablanca and Rabat are.

The protest yesterday comes after two months of heavy disagreement between medical students and the Ministry. Since Sept. 1, medical students have been boycotting classes and are on strike in hospitals. This new standoff comes as no surprise. The relationship between the Ministry and doctors has been strained for years. Tensions have been building, and now it looks like they are set to explode.

There is no denying the challenge the Ministry is facing. There are not enough doctors in Morocco. (Then again, where are there enough doctors and nurses?) Those that are there are are mostly pooled in the big cities. Access to basic care for those living in rural areas is still very poor. Corruption remains rife in many healthcare centers. And Morocco faces the most basic, common, and profound of challenges: There is a lack of financial resources in public health. It is not a national political priority. There is only so much that introducing new medical coverage programs such as RAMED can do. You have to have the infrastructure to back these initiatives up.

(Photo: Huffington Post Maroc)

(Photo: Huffington Post Maroc)

(Photo: Huffington Post Maroc)

At a Moroccan hospital. (Photo: Huffington Post Maroc)

On the other hand, the students have a point. The suggested pay of less than 350 dollars a month for two years, after eight years of study, is very low. The students will have no choice where they are sent. Many doctors struggle to get a job after they graduate from medical school. With almost no possibilities for career advancement, almost no continuous education or training programs, stressful and difficult working environments, and no financial incentives, what is there to motivate staff? Why should young people dream of becoming doctors?

The students’ determination to improve salaries, working conditions, job opportunities, and above all, oppose compulsory medical service has been impressive. Their protests and communications have been peaceful, well organized and effective. They have succeeded in making their voices heard. Here are some of their campaign posters:

Morocco posters

Although I see both sides of this argument, the thing I find most encouraging is that the debate is happening. Through highlighting the human resources issue, medical students have helped provoke a national conversation about public health in Morocco. It is time to face up to the deep structural issues that exist, and the price the people pay for them. Last night, after the protests, I sat in a café to drink my mint tea. All around me, debates were taking place about how these problems are going to be solved. There is no doubt: there are many more debates to be had and there is much more work to be done.

Echo Collins-Egan

Echo Collins-Egan

Echo Collins-Egan currently helps coordinate the Joint Learning Network for Universal Health Coverage and is the former country manager of ACCESS Health Morocco.

4 Comments

  1. Laura on October 29, 2015 at 1:03 pm

    One starts studying medicine for several reasons, passion for studying all the processes that ocur within a human being, how to study them, how to treat them, even how to prevebt them or how to develop new treatments, unfortunately there are several aspects that students do not consider when the get in this path.

    In Colombia young doctors must complete one year of mandatory social service in rural areas ( bad conditions, pretry low wage, sometimes almost for free) in order to obtain the medical register which will allow us to practice medicine.

    The government takes advantage of the need of medical students to get the authorization to practice medicine and force them to practice medicine in bad conditions ,without taking into account all medical-legal consequences secondary to it and without taking into account that doctors are people too, they have the right to decide where and how many hours they want to work, they have to pay bills to and they should get a wage according to the job they do.
    Mandatory social service is created by government to make others take the responsability of corruption and the lack of commitment with health issues, in this case doctors.

  2. Dr. Himansu Basu on November 4, 2015 at 5:10 am

    One has to start from medical school – highlight the importance of public health issues and societal cultural issues in effecting satisfactory outcome in sick men and women in low resource settings. Using a top down approach using compulsion may not be wholly effective in keeping young students in unattractive rural settings. Please give them incentives, make them have ownership of rural health programme – have a bottom up approach as well. Try to make them proud owners of village health schemes – appeal to their humanitarian instincts……….

  3. Tack on November 4, 2015 at 3:57 pm

    Every human being have the right to have health access, that means that we have to organize an equall access to medical care anywhere. So if all our good doctors preferes practicing in cities somehow we have to find solutions for our population: cheeper medecine studying for rural practicing for exemple?
    The same problem exist in France ; in some region we canot find any doctors to take care of our old persons: it could be your father o your mother!

  4. Frank Togiatama on November 5, 2015 at 9:41 pm

    Yes. I am not a doctor but an Environmental Health Professional and have just about completed 2 years in Outback/ Regional Queensland (January 2016).
    I think the Australian Medical Association has a 6 Continuous Years Program Model – uncertain.
    But! Having a great time, met some great people and learnt MUCH, MUCH more!
    True, I cannot compare Morocco to Australia but I can tell you that Queensland alone is more than 1.8 million km² 🙂

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